MEDICARE: KAITLYN O'HARA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	R231497	MD

General Provider Information

NPI Number	:	1285464800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN O'HARA

Provider Business Mailing Address
First Line	:	2353 LACONIA CT
Second Line	:
City	:	CROFTON
State	:	MD
Zip	:	21114-3228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10750 COLUMBIA PIKE # 5021
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20901-4402
Country	:	US
Telephone Number	:	301-593-5440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2024
Last Update Date	:	08/07/2024

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Directions to “ KAITLYN O'HARA ” Practice Location

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